Contemporary Understanding and Management of Cerebral Vasospasm. A Practical Guide

Description

A walk through any intensive care unit in the world will quickly reveal that although we have made significant strides in the management of subarachnoid hemorrhage, we still have a long way to go. As practitioners, the status quo will never be good enough. The principal challenge, we face in caring for patients after successful endovascular or microsurgical treatment of their culprit lesions is the disheartening devastation caused by delayed cerebral ischemia. It is written by clinicians, for clinicians to provide real-world information based on our current understanding of the disorder with the hope that it will lay the foundation for optimizing treatments across the world. With that goal in mind, we embark upon this journey with you.

This book is meant to support practitioners, who are in the trenches caring for these patients. This book is also meant to serve as a practical resource for all involved in the care of subarachnoid hemorrhage patients.

Key Features

Despite prophylactic measures, multimodality detection monitoring and aggressive treatment interventions, the outcome for many can remain grim. There is no question that the etiologic heterogeneity of cerebral vasospasm mirrors the variability in its clinical management even amongst experienced providers.

Contemporary Understanding and Management of Cerebral Vasospasm: A Practical Guide is written by clinicians, for clinicians to provide real-world information based on our current understanding of the disorder with the hope that it will lay the foundation for optimizing treatments across the world.

Contents

1. The History of Cerebral Vasospasm 1
   Milo A Hollingworth, Ketan R Bulsara
2. Definitions and Epidemiology of Vasospasm 4
   Hardik Amin, David M Greer
3. Recent Topics and Advances in the Molecular Mechanisms Contributing to
   Cerebral Vasospasm in Subarachnoid Hemorrhage 8
   Robert J Claycomb, Kevin N Sheth
   Endothelin-1 8; Neuroinflammation and Host Defense 9; Antioxidants and Scavengers of
   Free Radicals 10; Tenascin-C and Platelet-Derived Growth Factor 10; Inhibition of HMG-CoA
   Reductase 10; Vasodilators 11; Antiepileptic Drugs 11
4. The Pathophysiology and Pathology of Cerebral Vasospasm Following Subarachnoid Hemorrhage 16
   David Y Hwang, Anita J Huttner
   Anatomic Considerations 16; Morphological Alterations in Cerebral Arteries after Subarachnoid
   Hemorrhage 17; Pathophysiology of Vasospasm 17
5. Imaging of Vasospasm: The Role of Magnetic Resonance Imaging in Subarachnoid
   Hemorrhage-Related Vasospasm 23
   Amit Mahajan, Michele H Johnson
   Pathophysiology 23; Techniques and Sequences 24; Magnetic Resonance Perfusion
   Imaging 24; Limitations of Magnetic Resonance Imaging 26; Hyperacute Magnetic Resonance
   Imaging Protocol 27; Role of Magnetic Resonance Imaging in Patients with Subarachnoid
   Hemorrhage 27; Perfusion Imaging 30; Vessel Wall Imaging 30
6. Imaging of Vasospasm: CT, CTA and CTP Correlated with Digital
   Subtracted Angiography in Cerebral Vasospasm 32
   Ajay Malhotra, Michele H Johnson
   Use of CT, Contrast CT and CTA as Noninvasive Techniques along with TCD and DSA
   to Identify Probability, Extent and Severity of Vasospasm 33; Technical Features and
   Scan Acquisition 34; Image Interpretation of Computed Tomography Angiography in
   Vasospasm 35; Accuracy of Computed Tomography Angiography for Identification and
   Stratification of Cerebral Vasospasm 38; Computed Tomography Perfusion in Cerebral
   Vasospasm 38; Limitations, Pitfalls and Problems 40
7. Imaging of Vasospasm: Transcranial Doppler Ultrasound Imaging: Detecting
   Intracerebral Arterial Vasospasm 43
   Jonathan D Kirsch, Michele H Johnson, Leslie M Scoutt
   Subarachnoid Hemorrhage and Vasospasm Detection 43; Technique 44; Doppler Ultrasound
   Physics 45; Biosafety 47; Doppler Evaluation of Vasospasm 48; Other Applications of
   Transcranial Doppler Imaging 52
8. Medical Management of Vasospasm 55
   Evie Marcolini, Emily J Gilmore
   Defining the Problem 55; Monitoring and Triggers 55; Triggers for
   Intervention 56; Hemodynamic Augmentation 57; Calcium Channel
   Blockers 58; Magnesium 58; Endothelin Receptor Antagonists 58; Statins 58;
   Nitric Oxide 58; Fever Control 59; Hyponatremia 59; Adrenal Insufficiency 59
9. Electroencephalogram Monitoring of Vasospasm 62
   Nicolas Gaspard, Emily J Gilmore, Lawrence J Hirsch
   Cellular Basis of Electroencephalogram Activity 62; Modifications of Brain Metabolism and
   Electroencephalogram Activity Secondary to Ischemia 62; Electroencephalogram Studies in
   Patients with Aneurysmal Subarachnoid Hemorrhage 63; Continuous Electroencephalogram
   Monitoring for Ischemia Detection 63; Quantitative Electroencephalogram Analysis with the Fast
   Fourier Transform 64; Artifacts and the use of Intracortical Electroencephalogram 67;
   Other Confounding Factors and the Need for Multimodality Monitoring 67; Continuous
   Electroencephalogram for the Monitoring of Treatment 68; Future Developments 68
10. Anesthesia for Neurointerventional Surgery 70
    Keith J Ruskin
    Anesthetic Management 70; Radiation Protection 73
11. Practical Microsurgical and Endovascular Treatment of Vasospasm 75
    Ryan A Grant, Ketan R Bulsara, Charles C Matouk
    Pathogenesis of Cerebral Vasospasm 75; Medical Prevention and Treatment of Cerebral
    Vasospasm 76
12. Special Populations 85
    Lauren A Beslow, Jonathan D Kirsch
    A. Pediatric Subarachnoid Hemorrhage 85
    Lauren A Beslow
    B. Sickle Cell Disease 86
    Jonathan D Kirsch

Appendix: Clinical Protocols 89
Subarachnoid Hemorrhage Protocol 89
Vasospasm Protocol 91
Abbreviations 92
Index